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首页> 外文期刊>European journal of gastroenterology and hepatology >Insulin resistance: A major factor associated with significant liver fibrosis in Egyptian patients with genotype 4 chronic hepatitis C
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Insulin resistance: A major factor associated with significant liver fibrosis in Egyptian patients with genotype 4 chronic hepatitis C

机译：胰岛素抵抗：与埃及基因4型慢性丙型肝炎患者明显肝纤维化相关的主要因素

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BACKGROUND AND AIMS: The role of insulin resistance (IR) in chronic hepatitis C genotype 4 (CHC-4) patients is still under assessment. The aims of this study are to assess the prevalence and predictors of IR and its influence along with clinical, metabolic, virological, and histological factors on the severity of liver fibrosis in 100 Egyptian patients with CHC-4. PATIENTS AND METHODS: In 100 untreated patients with CHC-4, IR was assessed using the Homeostasis Model Assessment and defined greater than 3. By logistic regression (LR), independent factors associated with IR and significant fibrosis (SF=fibrosis, Metavir score≥F2) were assessed in nondiabetic and noncirrhotic patients. RESULTS: One hundred patients were included; 54% were men and 46% were women. The mean age of the patients was 40.46±9.41 years. Of the total patients, 55% were overweight and 28% were obese. Metabolic syndrome was observed in 26% of patients; five of them were known to be diabetic. All patients were genotype 4. Most of our patients had mild viremia (<2 00 000 IU/ml), whereas only 16% had higher viral load (>2 00 000 IU/ml). There was no correlation between IR and hepatitis C virus viremia (r=-0.069; P=0.492). Necroinflammation was moderate-severe (A2-A3) in 25% of patients. SF (F2-F4) was found in 46% of patients and 11% had cirrhosis (F4). Most of our patients, 54%, had moderate steatosis and 21% had severe steatosis. IR was present in 46% of patients; 39 (42.9%) were nondiabetic, which is correlated significantly with BMI (r=0.395; P<0.01). IR was found to increase significantly with the fibrosis stage (P=0.001), insignificant fibrosis, 18.5%, SF (F2-F4), 71.4%, and cirrhosis (F4), 100%. By LR, IR was independently and significantly associated with age more than 40 years, obesity (BMI>30 kg/m), SF, and severe steatosis (>30%). IR was also significantly associated with metabolic syndrome. SF was present in 46 patients (46%). It was associated with IR, moderate-severe necroinflammation, and severe steatosis. By LR, in noncirrhotic patients, SF was associated with age more than 40 years, obesity (BMI>30 kg/m), moderate/severe liver inflammation, and severe steatosis. CONCLUSION: In CHC-4 patients, IR is highly prevalent and independently associated with age, obesity, SF, and severe steatosis. Management of IR might significantly improve the prognosis of CHC-4 patients.
机译：背景与目的：胰岛素抵抗（IR）在慢性丙型肝炎基因4型（CHC-4）患者中的作用仍在评估中。这项研究的目的是评估100例埃及CHC-4患者中IR的患病率和预测因素及其对临床，代谢，病毒学和组织学因素的影响，对肝纤维化的严重程度。患者和方法：在100例未经治疗的CHC-4患者中，使用稳态模型评估对IR进行了评估，并将其定义为大于3。通过逻辑回归（LR），与IR和严重纤维化相关的独立因素（SF =纤维化，Metavir评分≥ F2）在非糖尿病和非肝硬化患者中进行评估。结果：包括一百例患者。男性为54％，女性为46％。患者的平均年龄为40.46±9.41岁。在所有患者中，超重55％，肥胖28％。在26％的患者中观察到了代谢综合征。其中五个被认为是糖尿病患者。所有患者均为基因型4。我们的大多数患者患有轻度病毒血症（<2 000 IU / ml），而只有16％的病毒载量较高（> 2 000 IU / ml）。 IR与丙型肝炎病毒病毒血症之间无相关性（r = -0.069; P = 0.492）。 25％的患者中有坏死性中度严重炎症（A2-A3）。在46％的患者中发现了SF（F2-F4），而肝硬化（F4）则为11％。我们的大多数患者（54％）患有中度脂肪变性，而21％患有严重脂肪变性。 46％的患者存在IR; 39名（42.9％）为非糖尿病患者，与BMI显着相关（r = 0.395; P <0.01）。发现随着纤维化阶段（P = 0.001），不明显的纤维化，18.5％，SF（F2-F4），71.4％和肝硬化（F4），100％，IR显着增加。通过LR，IR与40岁以上年龄，肥胖（BMI> 30 kg / m），SF和严重脂肪变性（> 30％）独立且显着相关。 IR也与代谢综合征显着相关。 SF存在于46例患者中（46％）。它与IR，中度重度坏死性炎症和严重脂肪变性有关。通过LR，在非肝硬化患者中，SF与年龄超过40岁，肥胖（BMI> 30 kg / m），中度/重度肝炎和严重脂肪变性相关。结论：在CHC-4患者中，IR非常普遍，并且与年龄，肥胖，SF和严重脂肪变性独立相关。 IR的管理可能会显着改善CHC-4患者的预后。

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